目的 探討難治性青光眼應(yīng)用復(fù)明片聯(lián)合拉坦前列素治療的臨床效果。方法 選取2015年10月-2018年10月孝感市中心醫(yī)院收治的100例（187眼）難治性青光眼患者，隨機(jī)分成對(duì)照組（n=50，94眼）和治療組（n=50例，3眼）。對(duì)照組予以拉坦前列素滴眼液，1滴/次，1次/d，于每日晚間滴入患眼。治療組在對(duì)照組基礎(chǔ)上口服復(fù)明片，5片/次，3次/d。兩組均連續(xù)治療12周。比較兩組降眼壓療效，治療前后最佳矯正視力及相關(guān)24 h眼壓參數(shù)值、視野指標(biāo)[平均敏感度（MS）、平均缺損（MD）、丟失方差（LV）]、眼動(dòng)脈血流動(dòng)力學(xué)參數(shù)[收縮期峰值流速（PSV）、舒張末期流速（EDV）、血流阻力系數(shù)（RI）]值和視功能相關(guān)生存質(zhì)量量表-25（NEI VFQ-25）評(píng)分變化。結(jié)果 治療后，對(duì)照組和治療組的總有效率分別是71.3%、83.9%，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組治療后最佳矯正視力的頻數(shù)分布均顯著優(yōu)于治療前（P<0.05）；但治療后，治療組最佳矯正視力的頻數(shù)分布較對(duì)照組同期顯著更優(yōu)（P<0.05）。兩組治療后24 h眼壓相關(guān)參數(shù)（峰值、平均值、波動(dòng)值）均顯著降低（P<0.05）；且治療組以上24 h眼壓相關(guān)參數(shù)值下降更顯著（P<0.05）。治療組治療后視野MS值較治療前顯著增高，MD、LV值則均顯著減?。?i>P<0.05）；但治療前后對(duì)照組上述視野指標(biāo)變化均不明顯。治療組治療后眼動(dòng)脈PSV、EDV值均顯著高于治療前，而RI值顯著降低（P<0.05）；治療后，治療組眼動(dòng)脈血流動(dòng)力學(xué)參數(shù)明顯優(yōu)于對(duì)照組（P<0.05）。但對(duì)照組治療前后以上眼動(dòng)脈血流動(dòng)力學(xué)參數(shù)（PSV、EDV、RI）值亦均無(wú)明顯改變。兩組治療后NEI VFQ-25評(píng)分均顯著低于治療前（P<0.05），而治療組下降更顯著（P<0.05）。結(jié)論 復(fù)明片聯(lián)合拉坦前列素治療難治性青光眼有助于維持患者眼壓穩(wěn)定，提高視力，改善視野損害及眼部血流動(dòng)力學(xué)，提高患者生命質(zhì)量，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the clinical effect of Fuming Tablets combined with latanoprost in treatment of refractory glaucoma. Methods 100 Patients (187 eyes) with refractory glaucoma admitted to Xiaogan Central Hospital from October 2015 to October 2018 were randomly divided into control group (n=50 cases, 94 eyes) and treatment group (n=50 cases, 93 eyes). Patients in the control group were given Latanoprost Eye Drops, 1 drop/time, once daily, dropped into the affected eye every night. Patients in the treatment group were po administered with Fuming Tablets on the basis of the control group, 5 tablets/time, three times daily. All patients were treated for 12 weeks. The IOP lowering effects of the two groups were compared. The best corrected visual acuity and related 24 h IOP parameter values, visual field indexes[mean sensitivity (MS), mean defect (MD), loss variance (LV)], ophthalmic artery hemodynamic parameters[systolic peak flow rate (PSV), end diastolic flow rate (EDV), blood flow resistance coefficient (RI)], and NEI VFQ-25 score in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups was 71.3% and 83.9%, respectively, and there were differences between two groups (P<0.05). The frequency distribution of best corrected visual acuity after treatment in both groups was significantly better than that before treatment (P<0.05). However, after treatment, the frequency distribution of the best corrected visual acuity in the treatment group was significantly better than that in the control group (P<0.05). Compared with that before treatment, the IOP related parameters (peak value, average value and fluctuation value) of the two groups were significantly reduced 24 h after treatment (P<0.05). In addition, the IOP-related parameters decreased more significantly in the treatment group over 24 h (P<0.05). After treatment, the visual field MS value in the treatment group was significantly higher than that before treatment (P<0.05), while MD and LV values were significantly decreased (P<0.05). However, the changes of the above visual field indexes in the control group were not significant before and after treatment. After treatment, PSV and EDV values of ophthalmic artery in treatment group were significantly higher than before treatment (P<0.05), while RI values were significantly lower (P<0.05). After treatment, the mechanical parameters of ocular arterial blood flow in the treatment group were significantly better than those in the control group (P<0.05). However, the hemodynamic parameters (PSV, EDV, RI) of the above ophthalmic artery in the control group did not change significantly before and after treatment. After treatment, NEI VFQ-25 score in both groups was significantly lower than that before treatment (P<0.05), while that in the treatment group was significantly lower (P<0.05). Conclusion Fuming Tablets cmbined with ltanoprost in treatment of refractory glaucoma has a significant overall effect in the treatment of refractory glaucoma, and can effectively reduce the intraocular pressure of patients and maintain the relative stability of intraocular pressure, improve visual function such as vision and visual field, correct ocular hemodynamic abnormalities, improve the life quality of patients, which has a certain clinical application value.

R988.1